Alcohol and Stroke: You May Be Just Asking For It

Question: “My mother had a stroke three years ago. With intensive rehabilitation, she is now able to function pretty well. She is 60 now, but up until the time of the stroke, she drank almost every day. At the most she would have four or five drinks, but regularly. I never saw her drunk. These drinks would always be separated in the most ‘civil and socially acceptable manner.’ We were shocked a few weeks ago when a physician friend recommended that she abstain from alcohol. He said her drinking might well have caused her stroke. Is this possible?”

Dr West: “It is not only possible, but also probable. Having four or five drinks a day, no matter how socially graceful and acceptable at the Country Club, or any other social setting, is heavy drinking. The risk of high blood pressure is 50 percent higher in persons drinking three or four drinks a day than in non-drinkers. Hypertension is a major risk factor for cerebro-vascular hemorrhage (stroke), as well as myocardial infarction (heart attack).

“The four or five drinks your mother consumed are associated with a fourfold increase in the risk of a hemorrhagic stroke. This kind [of stroke] is commonly fatal, or always disabling stroke, is much more common in female heavy drinkers than in men who drink an equal amount. As she now re-enters her world of social functioning, it is imperative that she refrain from alcohol. Her risk of suffering another alcohol-related stroke is the same, or maybe even greater, than before.”

Denise Mann, for WebMD Health News, in conjunction with Louise Chang, MD, said the same as West did years later. Mann wrote in 2012, “Heavy drinkers may be at a much greater risk for a bleeding stroke.”

A new study suggests “people who drank about three or more alcoholic drinks per day also had the strokes almost a decade and a half before those who didn’t drink quite as much.”

Mann goes on to say, “The study included 540 French people with an average age of 71 who had a less common type of stroke called an intracerebral hemorrhage. This type of stroke is caused by bleeding in the brain, not a blood clot.

“The people in the study and/or their caregivers or relatives were asked about drinking habits. Fully 25% were heavy drinkers. This was defined as having about three or more drinks per day, or about 1.8 ounces per day of “pure” alcohol.

“The heavy drinkers were about 60 when they had stroke. By contrast, the people who were not heavy drinkers were about 74 when they had a stroke. The heavy drinkers were also more likely to be smokers and did show some evidence of irregularities in their blood that would make them more likely to have a bleeding stroke.”

Deepak L. Bhatt, MD, MPH, a cardiologist at Brigham and Women’s Hospital in Boston and an associate professor at Harvard Medical School, concurs.

“The study does add to our knowledge that excessive drinking is bad for our health in a variety of ways, including increased risk of bleeding into the brain.”  

Bhatt says heavy drinkers may be more likely to have high blood pressure, which is a major risk factor for stroke. “If someone enjoys drinking, I don’t discourage them, but I will caution them even more so after this study to make sure that the amount is considered moderate.”

“We do know that one glass of red wine a day, on average, lowers heart attack and stroke risk, and that is still true,” says Dr. Patrick Lyden, the chair of the department of neurology at of Cedars-Sinai Medical Center in Los Angeles. “If you don’t drink, don’t start because you think it will protect your heart, and if you do drink, keep it moderate. My rule of thumb is one glass of wine a night, and that is the same as a glass of beer or one mixed drink,” he says.

“This doesn’t mean you can save them up and have seven drinks on a Saturday.” (Even I know that!)

“Certain people should avoid alcohol, including those taking blood thinners,” says Leyden. (I know that, too).

Another voice heard from, as recently as this year, is Jose Vega MD, PhD, on the site Medscape. “Although alcohol in moderate amounts can protect you from having a stroke, there is no doubt that excessive intake can increase your risk of having a stroke. Chronic excessive alcohol intake can precipitate all types of stroke, and most notably sharply raises the risk of hemorrhagic stroke. This is, in many cases, the result of harmful effects of alcohol on the liver, as this organ makes proteins which are necessary to prevent spontaneous bleeding.”

Yet more. A study found that drinking more than two alcoholic beverages a day when you reach middle-age raises the risk of a stroke in early old age more than do traditional risk factors, such as high blood pressure and diabetes.

The study published online January 29 in Stroke, with author Pavla Kadlecová, MSc, St. Anne’s Hospital, Brno, Czech Republic, found that individuals “who consumed more than two drinks a day during middle age had double the risk for stroke between the ages of 60 and 75 years compared with those who consumed an average of half an alcoholic drink per day.”

And finally, there comes the Copenhagen City Heart Study, with Dr. Thomas Truelsen et al, which found that “there may be differences in the effect of beer, wine, and spirits due to properties other than ethanol, a topic that has gained only little attention in stroke research. The differences in the effects of beer, wine, and spirits on the risk of stroke suggest that compounds in the wine in addition to ethanol are responsible for the protective effect on risk of stroke.” Grapes, perchance? The study didn’t say.

So my conclusions? If you don’t drink alcohol, don’t start. If you take blood thinners, really stop. If you do imbibe, watch the amount, especially if you’re middle-aged or older.